Ben Nelson: From 60th vote to ACA’s implementation

Former Sen. Ben Nelson’s Obamacare legacy won’t end with the so-called Cornhusker Kickback.

The Nebraska Democrat, the holdout who eventually provided the key vote for President Barack Obama’s health care law, will head up the nonpartisan National Association of Insurance Commissioners — and that means he’ll be way more involved in the nitty-gritty of Obamacare than anyone could have imagined three years ago.

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As CEO, earning nearly $1 million a year, Nelson will be a leading intermediary between the states and Washington. The states are trying to implement the wide-ranging law without sinking their health insurance markets — or giving up too much of their traditional regulatory turf. And the U.S. Department of Health and Human Services is working like mad to get the law ready in time for 2014 — including in states that aren’t exactly bending over backward to help.

Nelson’s hiring gives the NAIC a high-profile leader who knows the ins and outs of state and federal policy at a time when states are struggling to understand the new environment. Though Nelson’s portfolio includes major items, like storm recovery and insurance-related aspects of Dodd-Frank, the immediate Obamacare deadlines put health care concerns front and center before the major coverage expansions take effect in 2014.

Nelson’s post-Senate gig offers cynics one of those “only in Washington” moments: The conservative Democrat who nearly doomed the president’s landmark health care law is getting paid to help carry it out now that he’s in the private sector.

While plenty of health care groups have spent the past few years throwing jabs at Obamacare, that’s not the NAIC style. The regulators have been thinking through policy questions and seeking common ground in an industry where that’s often hard to come by.

“There’s a division of opinion and positions within the NAIC, and the NAIC has been able to navigate very carefully through these differences of opinion,” Nelson said on a press call Wednesday when he was introduced in his new role.

The call came soon after reports that Nelson also will be joining the public-affairs firm Agenda as a senior adviser.

Nelson himself has a complicated history on the health care law. He skated close to sinking it in 2009 — but after he announced he would not seek reelection, he began speaking out more favorably. He criticized “activist” Supreme Court judges who could strike it down and clashed with Nebraska’s Republican governor for refusing to set key parts in motion.

Now, Nelson goes from being an advocate for the law to backing states’ ability to carry it out on their terms.

It’s an odd position given that his vote was so much in doubt in December 2009.

During the drafting of the Affordable Care Act, Nelson withheld support for weeks until striking a deal to become the 60th Democrat to support the bill, allowing the Senate to take its memorable Christmas Eve vote. Nelson gave his support after a provision bringing in bonus Medicaid dollars for Nebraska was added — a move Republicans were quick to label the Cornhusker Kickback — a name he never quite lived down.

Though the provision was dropped from the final version, and Nelson denied trading his vote for the extra Medicaid funds, his political standing suffered. The failed Cornhusker Kickback drew so much bad ink that even Supreme Court Justice Antonin Scalia mentioned it disparagingly during last year’s marathon oral argument on the health care law.